Provider Demographics
NPI:1215348388
Name:BOLTE, KENDALL M (PA-C)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:M
Last Name:BOLTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:M
Other - Last Name:MAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2114 N LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-1072
Mailing Address - Country:US
Mailing Address - Phone:402-362-5044
Mailing Address - Fax:402-362-7137
Practice Address - Street 1:2114 N LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1072
Practice Address - Country:US
Practice Address - Phone:402-362-5044
Practice Address - Fax:402-362-7137
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1873363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant